A Disorder I've Never Seen

“I’ve been trying to pick up stuff, and I can’t,” said a Ramada guest over the phone.

“You mean your arm is weak?” I asked.

“No. Once I grab it, it’s OK.”

“Is it numb?”

“It feels fine. But when I reach out for something, I miss it. It’s weird.”

The guest was elderly but in good health. I suspected I knew the problem.

“Take your forefinger and touch your nose,” I suggested. “Can you do it?”

“No,” he said. “I keep hitting my face.”

This was something I’d never encountered but luckily I remembered medical school neurology. This lady had suffered a cutoff of blood to her cerebellum, a structure at the base of the brain that controls coordination.

When you reach out, the brain instructs muscles to move your arm in the general direction of your goal. That’s the best it can do. The last few inches don’t require strength or mobility but fine, precise movements. That’s where the cerebellum takes over.

With the cerebellum out of action, you’d have normal consciousness, strength, and sensation but no coordination. You could walk but only slowly with a clumsy, wide-based gait. If you reached for something, your hand would wobble wildly as it approached. The classic test is to ask a patient to put a finger on her nose. With the cerebellum out of action, it’s almost impossible.

It could have been a temporary loss of blood supply, a “transient ischemic attack” (TIA) or a permanent loss, a stroke. Waiting to see which would be unwise, so I urged her to go to a hospital.

A Dog-Eat-Dog Business, Part 5

I was attending a guest at Le Mondrian when there was a knock. The guest was not dressed, so I opened the door to find myself eye-to-eye with another doctor. I recognized him as one of the new concierge physicians eager to serve hotels, including mine.

Hotels occasionally summon a second doctor when the first is slow arriving. The sight of this doctor meant that Le Mondrian had called him first, unsettling news.

“Looks like a communications slip-up,” he said cheerfully. “It’s nobody’s fault,” he added. “But it’s only fair, since we both made the trip, that we split the fee.”

I closed the door in his face and went back to work. When I returned to the lobby, the concierge apologized for the mix up, blaming the impatient guest.

She handed me an envelope. A few luxury hotels prefer paying me directly and adding it to the guest’s bill. When I counted the money later, I saw it was too little. She had given half to the other doctor. If she hadn’t, I realized, she wouldn’t have received her referral fee.

The Free Market Strikes Again!

I spend less than $1,000 a year for supplies, so giving them out gratis is no sacrifice. Two or three times a year, I place an order at a pharmaceutical web site. It’s easy, but sometimes I get a jolt.  

I hand out doxycycline, an old antibiotic and the recommended treatment for the most common pneumonia and the most common sexually transmitted disease. In 2012 I paid $50 for a bottle of five hundred. That’s twenty-five treatments which works out to $2.00 for each. When I ran low in 2014 I decided to reorder. Checking the web revealed that five hundred seemed to cost $1,655. That couldn’t be right, so I looked around, but it wasn’t a typo. So I ordered azithromycin, effective and about $4.00 per treatment.

This happens regularly. Remember penicillin? You may think it’s obsolete, but it remains a superb antibiotic and the best treatment for common infections from strep throat to syphilis. Twenty years ago it was as cheap as aspirin. I could buy a thousand for $30. Now the price is $130 and rising.

Here’s what happens. As a drug gets older and older, it gets cheaper and cheaper. But doctors like newer drugs. Everyone (you included) believes they are immune to advertising, but you’re not, and doctors are no different.

It’s a good rule that any drug in an ad is wildly expensive and not superior. Look at the ad: if it doesn’t say the drug is the best, it isn’t. A few years ago Avelox or Levoquin would cure your pneumonia as well as doxycycline at forty times the cost. Doxycycline at $1655 a bottle still costs less but not by as much.

As doctors incline toward a new drug, they prescribe the older one less. Pharmacies buy less. Pharmaceutical companies stop making it. Eventually the remaining companies notice the absence of competition, and the free market works its magic.   

Cheating Medicare

Hearing my fee, the guest announced that he was on Medicare. I explained that I am not a Medicare doctor, so he would have to pay me up front. Unlike most elderly callers, he preferred another source of care, so I gave directions to a local clinic.

Medicare pays less than the going rate for all medical services. I don’t know any hotel doctor who accepts it. Among the ninety percent of office physicians who bill Medicare, many work hard to tack on extra charges for tests and procedures and length-of-visit to compensate for the low reimbursement. This is cheating, but doctors routinely cheat Medicare. After all, they point out, Medicare cheats them.

Most doctors are conservative, so they blame Medicare’s behavior on government bureaucrats. Being liberal, I blame society. The U.S. is a democracy, and most Americans don’t want to pay enough taxes to finance Medicare adequately. No elected representative, Republican or Democrat, would dream of forcing them.

As a result, a Medicare bureaucrat behaves like any intelligent person required to pay bills without enough money. He quibbles, quarrels, delays, discovers errors in the invoice, makes partial payments and sometimes no payment at all. This infuriates doctors but allows the Medicare budget to last out the year. Paying bills promptly would exhaust the money early, infuriating the bureaucrat’s boss. 

A Dog-Eat-Dog Business, Part 4

Danielle, chief concierge of the Ritz-Carlton, calls when her allergies are acting up, but this wasn’t the reason. It was an awkward situation, she explained, but she hoped I’d understand. A guest has complained, I thought. I racked my brain to think who it might be.

If it were up to her, she added, I would be the Ritz-Carlton’s doctor no matter what. Unfortunately, other concierges were putting pressure on her. Another hotel doctor had approached, offering thirty dollars for every referral. She had brushed him off, but her colleagues objected. They reminded her that vendors who want a hotel’s business (limousine services, tours, florists, masseurs) routinely tip the concierges. Why should doctors be exempt?

Here’s a suggestion, she said. Why didn’t I simply match his offer?

I told her that I’m happy to provide free care to hotel staff, but it’s unethical for a doctor to pay for a referral. It’s also illegal. No problem, she assured me. I would still be the Ritz-Carlton’s doctor.

Danielle might continue to call, but I’m less certain about her colleagues.

This exchange reminded me that I hadn’t written the California Medical Board in a few years, so I sent off another letter complaining about other hotel doctors paying referral fees. I’ve sent several. The board is legally obligated to respond to every complaint, and it duly responded, assuring me that it was aware of the problem.

It has never taken action, probably because the Medical Board gives priority to protecting patients from doctors. It shows less interest in protecting doctors from each other.

A Miracle Drug

Handing me a vial of an injectable medication, a guest explained that he needed a refill. Its label was in Spanish, but technical terms are recognizable in any language, so I had no trouble deciphering its mixture of vitamins and minerals. And cortisone.

That was disturbing. The guest’s wife’s rheumatoid arthritis occasionally flared up, and her doctor in Argentina wanted to make sure this didn’t spoil their vacation.

Discovered in the 1940s, cortisone seemed miraculous. Patients crippled with arthritis saw their pain melt away. Ugly psoriatic plaques disappeared. Hay fever vanished. Eczema victims who had been scratching for years stopped after a few doses of cortisone.

A cure for cancer could not have produced more excitement. The Nobel committee, which prefers to wait decades, rewarded cortisone in 1950 - just as doctors were realizing that symptoms return with a vengeance when the effect wears off, and repeated use produced disastrous side-effects.

Creams are fairly safe, and cortisone taken internally remains a life-saver for many serious diseases but a bad idea for ongoing symptoms (generalized pain, itching, inflammation). Large amounts for a short period are safe provided the problem is also short-lived. I give a huge dose for poison ivy but stop after two weeks. By that time the poison ivy has run its course.

A rare shot is probably OK for arthritis, but this family’s G.P. used it generously, a common tactic because the short-term effect is so good. There are no benign treatments for rheumatoid arthritis, but many are safer than cortisone. I prescribed enough for one shot.  

A Treatment Better Than the Best

She had a fourteen hour flight to Australia, explained a woman with a thick French accent. Unfortunately, she had thrown her back out again. Would I come and give something to relax her muscles for that long journey?

I don’t know any medicine that does that, but she was certain that, in the past, her French doctor had prescribed something that did the trick. 

She was already taking the usual pain remedies, so there was no point in a housecall. The woman agreed, but she was clearly disappointed. I know she wondered if I was truly on the ball.

It’s a popular medical belief (remember reader: all popular medical beliefs are wrong) that if you are sick, the doctor will do his best. But if you absolutely must feel well – you have a vacation, important business, a wedding – a smart physician will make a special effort and come up with something even better.   

As a hotel doctor, I deal with this yearning all the time. Since doctors are tenderhearted, it’s tempting to prescribe a placebo if no useful medicine exists. Placebos work although not as dramatically as enthusiasts claim.

The problem is that they’re not available. Decades ago, drug companies sold pills labeled “placebo,” but, perhaps for medicolegal reasons, they stopped. The result is that when a doctor decides you need a placebo, he prescribes a real medicine in the full knowledge that he’s doing something wrong. As I’ve written repeatedly, the advantage of alternative, folk, holistic, and herbal healing is that their medicines are a hundred percent safe. Medicines from real doctors have side-effects, so we’re not supposed to prescribe them unless they’ll help.

Life is easier for doctors who ignore this, so many do.

An Unwelcome Visitor from the Past

A young man at the Chateau Marmont had been coughing for two weeks. He had a fever, and my stethoscope revealed lung noises typical of pneumonia.

I enjoy diagnosing pneumonia because, in an otherwise healthy person, it’s the only common illness with a cough that doctors can cure. Everything else is a virus. 

I didn’t like this particular diagnosis. It takes a tough germ to cause pneumonia in most people, so unpleasant symptoms begin quickly. This man’s cough had persisted for some time. Furthermore, he was gay and admitted to having unprotected sex. I suspected that he had a pneumocystis infection. Pneumocystis is a fungus so benign that it lives in the lungs of most of us, causing no trouble.

Until forty years ago, it was rare, affecting patients already sick with cancer or serious diseases requiring drugs that suppressed immunity. Doctors were mystified when Pneumocystis began attacking previously healthy young men during the 1980s. It turned out to be the most common sign of AIDS.

It’s rare again today because we track immune cells of HIV patients and prescribe preventive drugs when the numbers drop. This young man had not been tested, but he was no fool. He cut short his visit and returned home.

The Glamorous Life of the Call Girl

At one a.m. in 1994, I received a call from Le Montrose, a boutique hotel in West Hollywood. The guest told me the problem was “personal.”

The man who opened the door was past sixty, short, plump, balding, and tieless, wearing a rumpled suit which I suspected he’d put on to greet me. Across the room, wearing a bathrobe, a young woman sat on the bed, staring sullenly at the floor.

“There’s been an accident,” he said.

Neither guest seemed injured, so I knew I wasn’t going to get off easy. This proved true as he explained that his friend seemed to have an object in her rectum. He provided no details.

Bizarre incidents fascinate doctors no less than laymen. Around the cafeteria table, interns compete in relating the latest. Outside of working hours, they remain a mainstay for impressing girls at parties.

Central to this adolescent obsession is the genre of things-that-end-up-in-people’s-rectums. I no longer find these amusing, not only because I’m a grown-up but because they make me nervous. I hate situations that I might not be able to handle. Removing something from the rectum often requires tools such as a proctoscope which I didn’t carry. Also practice. I had never done it.

But I had to try. After introducing myself to the woman, I put on a rubber glove and went to work. There is more space than you’d think inside a rectum; I felt a hard object touch my fingertip and then drift away. When something lies out of reach, it’s natural to stretch, and my desperate efforts caused her to groan with pain.

Suddenly, I snagged something and pulled out a shot glass. I almost danced with joy and relief. Although I expected an outpouring of gratitude, none appeared. Gathering up her clothes, the woman disappeared into the bathroom. The man nodded agreeably as if this were routine business. Filling out my invoice, I asked the woman’s name.

“Elizabeth Anderson.” He hesitated before answering, revealing that he had invented the name. Call girls lead a glamorous life in the movies, but the reality is often miserable. I handed him the invoice. He examined it thoughtfully. “That’s a lot of money,” he said. “You only spent five minutes here.”

In 1994 my fee for a wee-hour call was $180. He had not objected when I had informed him over the phone. When guests balk, I say I’ll accept whatever they consider fair. They often reconsider and pay my regular fee.

I told him I’d accept whatever he considered fair. He handed over $80. I don’t want to think how the woman made out.

Lost in Translation Again

“Bom dia” said the woman who opened the door.

“Bomn dia,” I responded. That’s the limit of my conversational Portuguese. My heart sank as I looked around the room which contained a toddler but no adult male. When I see a couple from a foreign country, the husband is likely to speak some English.

The mother pointed at her child, made coughing noises, tapped his chest, and produced a thermometer which she waved significantly. Once she understood that I needed more information, she took up her cell phone. 

After some effort because her husband was in a meeting she delivered a long recitation before handing me the phone.

I heard “He have cough. He have flu. He need medicine.”

In response to my question, the father insisted that this was everything she had said, but I knew he was summarizing. I asked more questions and received short versions of her long answers. The child looked happy and not at all sick, and my examination was normal. He had a cold. He’d coughed for four days and might cough for a few more, I explained. She was already giving him Tylenol, and no other medicine is safe for a two year-old. Luckily, he didn’t need medicine or bed rest or a special diet. It wasn’t even necessary to stay in the room.

If I had handed over a bottle of medicine, every mother from Fiji to Mongolia to Nigeria would understand that I was behaving like a doctor. But I wasn’t. What was going on?

I’ve encountered this hundreds of times, so I work very, very hard to communicate that the child has a minor illness (husband’s translation: “Doctor says child is OK…”), that no treatment will help (husband’s translation: “Doctor does not want to give medicine…”) and that being stuck in a hotel room is boring, so she should try to enjoy herself (husband’s translation: “Doctor says go out; child is OK…”).

Tap, tap, tap…. The mother beat a tattoo on he child’s chest in a wordless appeal. Everyone knows that a sick child must be confined and given medicine. Why did the doctor keep saying that he wasn’t sick?

I repeated my reassurance, and the husband translated. When, at the end, I asked if she understood she knew the proper answer: yes. She remembered her manners as I left and thanked me effusively.

I left feeling as discouraged as the woman. She was in a strange country, trapped in a hotel room with a sick child. Despite her best efforts, the foreign doctor didn’t understand that her son needed help.

An Untypical Case of Stomach Flu

I once cared for a Fiji Airline flight attendant suffering stomach flu. These are miserable episodes of cramps, vomiting, and diarrhea that rarely last long. She was better the following day, but on that day I returned to the hotel to see another flight attendant with similar symptoms.

In the hotel room, I repeated my stomach flu exam, delivered the usual advice, and handing over medication. She asked if the medication was safe if she were pregnant.

Doctors are human. Having made a diagnosis, my inclination was to stick to it, but I asked a few questions. Her period was overdue. She admitted that her nausea, although worse today, had begun a week ago. Her cramps, also worse today, had also been present.

One of many rules medical students learn is that when a young woman has abdominal pain, one always considers an ectopic pregnancy. That’s usually a pregnancy in the fallopian tube which, unlike the womb, had no room for the growing fetus.

I told the flight attendant that she needed a test to see if she had an ectopic pregnancy which is an emergency. She did not disagree. I phoned the agency that handles airline crew. Their medical department agreed that this was appropriate, and it turned out positive.

I've Quit Doing Telemedicine

Organizations like Amwell or Teladoc or Doctor on Demand pay doctors to answer phone calls. Sitting at home, we can earn $40 for a conversation that lasts a few minutes. It’s easy money, and I’ve had many satisfying experiences answering questions, helping with minor illnesses, assuring callers that something that seems ominous is not ominous, or sending them for medical care if they need it.

What spoils the experience is that nearly half of these callers are suffering a respiratory infection: cough, sore throat, congestion, “sinus,” “bronchitis.” Since their doctors routinely prescribe antibiotics, these callers know what they need. Phoning saves a trip to the office. What a convenience!

When, after discussing their symptoms, I give my diagnosis and explain how to help, many are puzzled. When, in answer to their hints, I assure them that antibiotics don’t help, most remember their manners, but they don’t believe me. Some point out that their family doctor takes their illness more seriously. A few question my competence or suspect they’ve fallen for another internet scam (“Are you a real doctor?.... What am I paying this money for?!!...).

When guests at my hotels phone, respiratory infections are also the leading complaint. But phone calls to me are free, and I spend a good deal of time answering questions and giving advice. By the time guests agree to a housecall, they understand that I know my business. If they don’t understand, I direct them to another source of care.

Telemedicine guidelines forbid doctors from prescribing narcotics and tranquilizers but say nothing about antibiotics which are far more toxic. If you sign up for one of these services and want an antibiotic but have the bad luck to reach a doctor like me, simply thank him, hang up, call again, and tell whomever answers that you want a different doctor. That should work.

A Message From a Stranger

“A guest would like to meet you at 4:15 in the lobby.”

The caller was a concierge at the L.A. Hotel.

“Is that all?”

“I’m sorry, Doctor Oppenheim. The guest just made the request and walked off.”

This really happened a few years ago. Doesn’t it sound like a bad novel? Retired CIA agent, Skip Oppenheim gets a message from a mysterious stranger as he unwinds at a luxurious hotel. The adventure begins.

As a hotel doctor, I am allergic to adventures. Sick guests rarely schedule a consultation in a public place. Most likely he had a request. I prefer to handle these over the phone at no charge. This is good P.R. but it’s also self-defense. If I travel to the hotel, and the guest makes a request I have to refuse, the consequences may not be life-threatening but they are not pleasant. Also, it’s hard to collect my fee.

“I don’t make appointments without talking to the guest first. Do you have his number?”

“I’m afraid not.”

“Have him call when he gets back. I’m sure we can work out something.”

The concierge agreed. Sadly for this post, there is no punch line. I never heard from him.

How a Hotel Doctor is Like a Prostitute

I make the majority of my calls at the request of national housecall agencies, international travel insurers, airlines, and a sprinkling of miscellaneous sources including other hotel doctors. That’s fine with me.

A few dozen Los Angeles area hotels call me exclusively. That leaves over a hundred, all of whom have my number but who call another doctor or no doctor and sometimes me. Competition for these hotels has become so cutthroat that I’m happy to leave it to others.

If you’ve followed my posts you’ve learned about my excellent skills and low fees. Why would a hotel bother with anyone else? The answer is that service and price are useless marketing tools in medicine where the law of supply and demand doesn’t work. 

Providing a doctor produces no revenue for the hotel, and guests don’t demand one, so most general managers pay no attention. Asked for help by a guest, employees are on their own. 

They may simply give out a number, but many prefer the traditional arrangement once used to summon a prostitute. A bellman made a phone call. As the lady left, she stopped at the bell desk to drop off a portion of her fee.

It’s illegal for a doctor to pay for a referral, but what are the options for someone yearning to break in to the glamorous and lucrative world of hotel doctoring? Claiming to deliver superior medical care sounds weird. Advertising a low fee is vulgar. Whoring works better.

Good Doctors Do It

“I’m coughing my head off. My head is plugged. I have a fever. I’m on vacation, and I need something.”

I’ve seen over 4,000 guests with respiratory infections. To the average hotel doctor, this is an easy visit. He arrives, performs the traditional exam, prescribes the traditional antibiotic, and accepts his fee and the guest’s thanks. What’s not to like?

That the antibiotic is unnecessary doesn’t bother the doctor, but it would bother me. Despite my colleagues’ insistence that patients demand an antibiotic, most of mine don’t. A small minority appear disappointed when I don’t prescribe one, and a tiny number make it painfully clear that I’ve missed the boat.

For decades, solemn editorials in medical journals have urged us to stop prescribing useless antibiotics, warning that they’re poisoning the environment, producing nasty, drug-resistant germs that are already killing thousands. 

Despite this, giving antibiotics for viral respiratory infections remains almost universal. Almost every doctor whose prescribing habits I know – admittedly a limited sample – does it. None believe they help. All tell me that patients expect them.

“I don’t want an antibiotic if I don’t need it,” patients often tell me. “But how do I know?”

“You don’t, but bacterial respiratory infections are rare in healthy people.”

“What if it’s bronchitis? I get that a lot.”

“Antibiotics don’t help bronchitis.”

“That’s what my doctor gives me. Are implying he’s incompetent?”

“No. Prescribing unnecessary antibiotics is so common that one could call it the standard of practice – meaning competent doctors do it.”

Easy Visits, Mostly

Every day a thousand airline flight crew spend the night in a Los Angeles hotel. Sometimes they get sick and call their supervisor. If they’re American, he tells them to take their American medical insurance and find a clinic. If they’re foreign, he tells them to stay put and wait for the doctor.

That will probably be me. I average half a dozen of these visits per month. I enjoy them because airline crew are young and healthy. Three-quarters suffer respiratory infections and upset stomachs. Since a doctor must certify if they’re fit to fly, I see plenty of ordinary colds.

A minor drawback is two pages of forms to fill out in addition to my medical record. A more serious problem is vomiting: the most common symptom. I hate driving during the rush hour, but vomiters don’t like to wait, so I often find myself creeping on the freeway.

Recovering From Cocaine

He had turned bright red, a frightened guest informed me. His search of the internet revealed that this indicated dangerously high blood pressure. Could I come…?

This was as accurate as most internet medical advice, so I was not alarmed. In response to my questions, he admitted using cocaine earlier but emphasized that he had never turned red before. His heart was pounding, his skin tingling, and his head pulsating but he denied having a headache or chest pain. Could I come?

What to do…. Allergic reactions turn patients red, but this is accompanied by itching which he didn’t have. Otherwise, his symptoms were typical of cocaine use. They didn’t sound life-threatening, but it’s a bad idea for a doctor to dismiss the possibility.

I do not like to make housecalls to frightened hotel guests. Waiting often becomes intolerable, so they dash off to an emergency room or call the paramedics before I arrive. When I suggested these possibilities, he refused, urging me to come quickly. I asked him to count his pulse. It was 100:  not terribly fast. I kept him talking, and he grew more calm.

A hotel doctor’s nightmare is a guest dying after he leaves the room, but dying before he arrives may be worse. It was a stressful drive.

When he opened the door, he didn’t appear bright red, perhaps faintly pink. When I took him to a mirror, he agreed that he had improved. His blood pressure was high, but not too high. His heart sounded normal. He was recovering from the cocaine.

A Sad Story

A Chinese caller wanted a medicine to take back home. He gave the name which, through his thick accent, sounded like “desitin,” an over-the-counter treatment for diaper rash.

That didn’t seem right, so I coaxed him through the spelling (“S as in Shanghai….? “T as in Taiwan…?). The result was “dasatinib.” This turns out to be a treatment for leukemia, FDA approved a few years ago and superior to other treatments. A sick friend in China had asked the guest to obtain some.

I fulfill these requests if they sound legitimate, and this qualified. I made sure he understood that he must find a pharmacy and explain exactly what his friend needed including the dose and instructions. This sometimes involves phoning back to the home country. The pharmacist would then call me, and I would approve. A trip to the hotel wasn’t necessary.

The guest had phoned in the evening and mentioned that he was returning to China the following morning. When the day passed with no call, I had the sinking feeling that, by delaying till his departure day, the guest had waited too long. The average CVS or Walgreens might not stock these high-tech, chemotherapeutic drugs, so the pharmacist might have to order it or send him to another specialized pharmacy. This might take hours. With a plane to catch, the guest probably realized that there wasn’t time. 

Sticking With the Errant Doctor

A guest had a flight in a few hours, explained the front desk manager of the Marina Marriott. His wife was ill and needed a doctor’s note to reschedule. How fast could I get there?

“Very fast,” I said. It was Saturday evening, and I was reading a book.

The Marriott had called regularly for decades before falling silent a few years before. Hotels occasionally do that, and this call gave me hope.

My competitors enjoy an active social life. It was the weekend, and hotels often turn to me when the regular doctor is hard to reach. After caring for the guest, I returned to the lobby and tracked down the manager who shook my hand.

“Thank you so much for coming,” he said. “We have your card.”

I drove off in a happy mood. These urgent requests arrive several times a year, and my prompt response has won me new clients.

But not often. Few hotels give a high priority to providing medical services. The Marina Marriott reverted to silence.

Still, I have fond memories. Twenty years ago, Loews in Santa Monica phoned when its regular doctor hadn’t appeared after several hours. I hurried, but when I knocked on the guest’s door, it was the regular doctor who answered. The embarassed manager promised to make it up to me and kept his word.

Rashes Are Easy, Part 2

His client had developed redness over her eyelids. Could I come?

As I wrote last time, rashes are easy, and eyelid rashes mostly turn out to be one of two or three diagnoses. I asked for the room number.

The guest was in a meeting, the caller responded. When I arrived, I should ask the concierge to fetch her.

So I did. The concierge phoned and informed me that the meeting would end shortly. I waited half an hour.

As expected, the eyelid rash was no problem. After accepting a tube of cream, she mentioned that her knee had hurt since her run the previous day. I examined the knee and reassured her. Then we talked about her husband who had a sore shoulder but refused to see a doctor.

Rashes are Easy, Part 1

A woman at a Sunset Strip hotel had seen a doctor for an allergic rash, and now she wasn’t feeling right. Rashes are easy, and her symptoms were probably medication side-effects, so I expected no problem. That seemed to be the case,, and she agreed to stop the medicine.

She handed me her credit card. I took out my cell phone, dialed the credit card company’s computer, and entered a series of numbers at its request. It denied approval. This is often the result of a typing error, so I entered the numbers again. Another denial.

In the distant past, guests would apologize and promise to send a check once they returned home. Some kept the promise, but I soon decided it was better to collect on the spot.

The guest seemed genuinely puzzled. She wondered if the hotel was responsible. At check-in, a hotel often places a hold on a large sum from the guest’s credit card to ensure that it gets paid. She wondered if this exceeded her limit. She phoned the front desk, and this proved true. There followed a long series of calls, referrals, consultations, and arguments before hotel management agreed to remove the hold. It worked. The computer reversed itself and approved.

Googling a Hotel Doctor

If you get sick in a local hotel, you might google “Los Angeles hotel doctor.” My name turns up but only with links to this blog. I don’t have a web site. Nor do my long-established competitors.

However, several young doctors eagerly offer their services. All promise to arrive promptly and deliver superior care. Don’t take their word for it. Rating services such as Yelp are unanimously enthusiastic. Five out of five stars.

In fact, sick guests are more likely to appeal to the hotel than the internet, but these doctors have also been working their charms on bellmen, concierges, and desk clerks.

All this takes money and work, but it’s not going to waste. Veteran hotel doctors possess an exquisite ability to detect an interloper, and these whippersnappers are definitely setting foot in my territory. Listening to my colleagues grumble, I know they are not immune.

As I complain regularly, only a minority of general managers have the good sense to designate an individual, usually me, as the house doctor. I have never solicited hotel employees. It wasn’t necessary when I began because there was no competition. I’m too shy or perhaps too lazy to begin. It would probably be a good idea. 

More Competition

A caller from the Airport Hilton asked how much I charged.

This is often the first question I hear. If I answer immediately, the guest is likely to thank me and hang up. So my first response is that phone calls are free and might be all he or she needs. What’s the problem?....

He wasn’t a guest, the caller replied. Hilton management was checking on what hotel doctors charged. There had been an unpleasant incident…. Hearing that I charged $300 most of the time, $350 for a call that got me out of bed, he responded that this was a big improvement and that he would pass along this information.

When I asked about the other doctor, the caller gave me an 800 number. I called it and learned that I was speaking to Doctors Housecalls. When I asked for the medical director, the person who answered said he was the owner.

When the owner answers the phone, that doesn’t suggest a prosperous business. I introduced myself as a long-standing Los Angeles hotel doctor. He immediately went into PR mode and told me of his burgeoning nationwide service. When I pointed out that I’d only learned of his existence today, he admitted that he was just getting started in the city. He asked me to send my CV.

I Have Syphilis

Those were the first words from a young flight attendant as soon as we had exchanged greetings.

Earlier, he had told his supervisor of a groin rash. I had popped a tube of antifungal cream into my bag and driven off, expecting an uncomplicated visit.

I asked how he knew this, confident that he had searched the internet and received the usual terrifying and incorrect information.

“My boy friend has the same sore. He went to a clinic. They did a test and said he had syphilis and gave him a shot of penicillin.”

I couldn’t argue with that. He would need the same test and injection. Since he was flying back the next day, he could take care of it then.

“I can’t!” he pleaded. “I don’t go to Australia for two weeks.”

His destination was Cairo because he worked for an Egyptian airline. On sexual matters Arabs are less easy-going than Australians, and he was frightened of the consequences if his employer found out.

I encounter this now and then. Even in the US where discrimination is illegal, employees worry. I never encounter syphilis, so I don’t carry injectable penicillin, but I handed over an approved alternative treatment, and he promised to follow up with his doctor in Australia. Later, writing my medical report for the employer, I worked hard to write an accurate if ambiguous description of a bacterial groin infection. 

Doctors Earn a Lot, Part 2

The best justification of our income lies in what we do:  we save lives, relieve suffering, and comfort the afflicted. Most of the time. I look on medicine as a noble, humanitarian calling, perhaps the noblest. Patients acknowledge this. So what’s the problem?

It’s that humanitarians shouldn’t make a lot of money. Few laymen believe clergymen, nurses, social workers, paramedics, teachers, policemen, or firemen are overpaid. They are less certain about doctors, but it doesn’t upset them if they have good insurance and enough money. Those without it rarely speak out or appear in the waiting room.

What are we doing about those who can’t afford us? Some doctors volunteer an afternoon or two. A few genuine humanitarians work full-time with the poor at an unacceptable salary. Most of us do little.

That statement produces an avalanche of disagreement. Poverty is no barrier in their practice, a chorus of doctors insists, but it is. Few doctors would refuse a patient who pleads for charity, but this doesn’t happen often.

Why don’t the needy call? They don’t hesitate to consult clergymen, social workers et al. I believe it’s because we are so powerful and prosperous and (ironically) because no influential group objects to this. In the debate over caring for the uninsured, no one wants doctors to shoulder the burden. Repeated cuts from insurers, Medicare, and Medicaid have had minimal effect on our income. Whatever changes occur in the years ahead, there’s no chance a physician’s income will come to equal that of, say, a teacher.

Doctors enjoy the best of both worlds. We care for the afflicted. For this we are widely admired and well paid. Sacrifices are expected - but only of our time and mental health. It’s hard to feel guilty because almost no one wants us to feel guilty.